Changes in the behavioural determinants of health during the coronavirus (COVID-19) pandemic: gender, socioeconomic and ethnic inequalities in 5 British cohort studies

Abstract

BackgroundThe coronavirus (COVID-19) pandemic and physical distancing measures are expected to have far-reaching consequences on population health, particularly in already disadvantaged groups. These consequences include changes in health impacting behaviours (such as exercise, sleep, diet and alcohol use) which are important drivers of health inequalities. We sought to add to the rapidly developing empirical evidence base investigating the impacts of the pandemic on such behavioural outcomes.MethodsUsing data from five nationally representative British cohort studies (born 2000-2, 1989-90, 1970, 1958, and 1946), we investigated sleep, physical activity (exercise), diet, and alcohol intake (N=14,297). Using measures of each behaviour reported before and during lockdown, we investigated change in each behaviour, and whether such changes differed by age/cohort, gender, ethnicity, and socioeconomic position (SEP; childhood social class, education attainment, and adult reporting of financial difficulties). Binary logistic regression models were used, accounting for study design and incorporating non-response weights, to estimate absolute differences in each outcome before and during lockdown within each cohort. Meta-analysis was used to pool cohort-specific estimates and formally test for heterogeneity across cohorts.ResultsChanges in these outcomes occurred in both directions, i.e. shifts from the middle part of the distribution to both declines and increases in sleep, exercise, and alcohol use. For all outcomes, older cohorts were less likely to report changes in behaviours compared with younger cohorts. In the youngest cohort (born 2001), the following shifts were more evident: increases in exercise, fruit and vegetable intake, sleep duration, and less frequent alcohol consumption. Widening inequalities in sleep during lockdown were more frequent amongst females, socioeconomically disadvantaged groups, and ethnic minorities. For other outcomes, inequalities were largely similar before and during lockdown, yet ethnic minorities were increasingly likely during lockdown to undertake less exercise and consume lower amounts of fruit and vegetables.ConclusionsOur findings highlight the multiple changes to behavioural outcomes that may have occurred due to COVID-19 lockdown, and the differential impacts across generation, gender, socioeconomic circumstances across life, and ethnicity. Such changes require further monitoring given their possible implications to population health and the widening of health inequalities.